Irene Mbugua | October 2015
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Presentation at the Global Maternal Newborn Health Conference, October 19, 2015

Background: Community Health Workers (CHWs) are an essential cadre needed to reach mothers and newborns in low resource settings. One of the challenges for building capacity of CHWs is ensuring a system-wide approach. We worked with 700 CHWs and the systems surrounding them in multi-country MNCH project in 3 countries in East Africa.

Methods:  We utilized the USAID CHW AIM toolkit, to retrospectively measure each CHW system against 15 functions. When applied at project baseline each function was scored and used to guide MNCH project implementation. Stakeholders included: Ministry of Health at facility, district and national levels; CHWs; NGOs; community-based organisations; community leaders; and community development committees. CHW supportive systems   had never been assessed in these districts.

Results:  All project areas demonstrated improvements in CHW functionality over the life of the projects. In Tanzania the score was 0.2 and “non- functional” in 2012 and by 2014 the score was 1.7 and “functional”. Improved referral systems, data collection and reporting by CHWs had improved. In Uganda the score was 0.9 and “partially functional” in 2012, by 2013 the score was 1.4 and by 2014 the score was 1.7 and “functional”. Continuous training, supervision and incentives for the CHWs are still areas of improvement. In Kenya the score of 1.4 and “partially functional” system in 2012 and by 2014 “functional” and a score of 2.2. Equipment and supplies for the CHWs, individual performance evaluation and opportunity for advancement have improved over the two year period. Sharing of results with the MoH in Kenya resulted in plans to scale up.

Conclusion: Assessing the functionality of the CHW system assists in planning and implementation of maternal newborn and child health programs which are reliant on CHWs to improve MNCH.